Objectives

Health care reforms refer to the recent changes and modifications that are made in health policies, particularly government policies. These reforms are found to affect the delivery of health care services at a particular location. The primary aim of health care reforms are to broaden the population that is receiving the health coverage, either via insurance programs in public sector or private sectors (Katon & Unützer, 2013). Kidd, McKenzie and Virdee (2014) state that the reforms also attempt to enlarge the range of the health care consumers, augment the quality of care, and reduce the associated costs. The principles of Catholic Social Teaching delivers the indispensable framework for thoughtful reasoning of the societal problems. With an increase in the aging population and associated costs of healthcare services, the Australian government has proposed several health reforms that have or will create an impact on the quality of life and health status of most Australians in future.

Reports from the government suggests that almost 1 in 3 people living in Australia, above the age of 45 live with a chronic health condition. Statistical reports suggested that more than 39% of potentially avoidable hospitalisations in the nation were due to chronic diseases during 2013-2014. Furthermore, more than 11 million Australians, which accounts for an estimated 50% of the entire population reported presence of at least one chronic conditions in 2014-2015 (Australian Government, 2018). The eight identified chronic diseases are arthritis, mental health conditions asthma, cancer, back pain, cardiovascular disease, diabetes, and chronic obstructive pulmonary disease. This report will elaborate on the NSW Mental Health Reform 2014-2024 and will explore its strategies and recommend future directions.

Mental health refers to the psychological, emotional, and social well-being and controls the way by which an individual acts, feels and thinks. Mental health is also responsible for assisting people in handling stress, relating to others, and making informed choices. Thus, mental health is utmost imperative to all stages of human life, beginning from childhood till old age. The NSW Mental Health Reform 2014-2024 was formulated by the Mental Health Commission, the primary role of which is to monitor, review and improve the status of mental health and wellbeing for all people residing in NSW (NSW Government, 2015). The Mental Health Commission of NSW referred to different sources for the development of a strategic plan that focused on mental health care in the NSW.

This led to the adoption of the Living Well: A Strategic Plan for Mental Health, a ten year road map 2014-2024 in 2014, by the government. The chief objective of the plan was to frame actions related to reform of the existing mental health system in NSW (Mental Health Commission, 2014). This also called for the need of effective collaboration between the non-government agencies, private sectors, and the NSW government, for improving the consequences for people residing with a mental disorders. The basic objectives of the health reform are given below:

• Strengthening the early intervention and prevention
• Shifting the emphasis to community based care services
• Emerging an additional responsive system (NSW Government, 2015)
• Working in an organised manner for delivering person-centred care
• Constructing a better system

Critical evaluation of strategy

The objectives of the health reform place a due reemphasis on the highly vulnerable group that comprises of young people and children. This can be recognised as a correct reform approach due to the high prevalence of psychiatric disorders in the target population. This can be accredited to the fact that 13.3% students belonging to the age group 12-17 years reported experiencing high psychological distress in the year 2014. While 17.2% of them were females, males were less likely to experience such mental distress (9.6%). Furthermore, in the year 2014, 33.3% students reported feelings of sorrow, wretchedness and/or depression (NSW Government, 2016). 16.5% of the population also stated that their behaviour in the past few months often landed them in trouble. Hence, it can be stated that the NSW government was correct in recognising the current state of mental health of the wider population.

The reform also focused on the transition of patients in psychiatric hospitals and tried to shift them to residential options that are community based. There is mounting evidence for the fact that community based health care encompasses a wide range of services and programs that are designed to meet the needs of the local population (Caplan, 2013). The community based programs that address mental needs of people include housing services, treatment options, case management, self-help programs, peer support, mobile crisis services, employment services, and club houses. Furthermore, efforts taken by the mental health reform to work towards delivery of person-centred care emphasises on the combination of mainstream health, human services, justice, mental health services, and commonwealth funded services (Grob, 2014). Scholarly literature by Yang and Anthony (2015) have focused on the fact that person centred care refers to the way that involves the people who are using the health care and social services. The service users are recognised as partners and their decisions are considered during the health planning, development, and care monitoring processes.

Thus, by placing the service users and their family members at the centre of the decisions that are related to mental health and wellbeing, the best outcomes will be obtained (Oldham, 2016). The fact that the NSW Mental Health Reform 2014-2024 objectives also focus on Strengthening Specialist Support is another step towards enhancing the mental health of the target population. Specialised support systems focus on the delivery of multidisciplinary care that allows people to commence their activities of daily living, as soon as possible (Mendenhall et al., 2014). Hence, the reform aims to implement specialist services that offer care options for people with mental needs, which are directed towards upholding their independence.

Opportunities for further reform development

The vision of the NSW Mental Health Commission is primarily focused on the people of NSW and intends to provide them with best opportunities for sound mental health and wellbeing, which in turn allows them live well in the wider community. This vision forms the core of the government mental health reform that aims to formulate a stable system of deterrence and early intervention, civic and infirmary based management and rehabilitation services (Beronio, Glied & Frank, 2014). In other words, combining the response to different mental disorders with certain opportunities for employment, housing, learning, and social interaction is a good approach in assisting people cope with their mental illness (Dennis & Monahan, 2013). The reform is also guided by a set of central values that commonly encompass, recovery, respect, community, quality, hope, and citizenship.

Recent trends on a global basis suggest that more number of people having been diagnosed with mental illnesses are residing in their communities, in place of spending considerable time in healthcare settings. This in turn is compassionate and steady with the expectations and aspirations of individuals with mental diseases, and their family members (Solbjør et al., 2013). In other words, the fact that the reform has recognised the need of shifting people from hospitals to their communities elaborates on the fact that it will try to treat or support people facing mental problems in a domiciliary setting, in place of some psychiatric hospital. The benefits of mental health services that promote dignity have also been recognised by the World Health Organization that defines it to be more effective, accessible, and helpful in eliminating or reducing social exclusion (WHO, 2015). This has resulted in the reform allocating $6.4 million for supporting an estimated 115 people in their transition to the larger community, besides an extra $1.6 million. Time and again, scholarly literature such as the article by Senior et al. (2013) have elaborated on the benefits of specialist mental health services that are basically designed for individuals suffering from serious mental disorders. The reform can therefore be stated correct in working towards providing tertiary level of health care, through the collaboration of highly trained interdisciplinary psychologists and psychiatrists, who specialise in their particular field. 

This approach of the reform will help people of the NSW who suffer from serious mental disorders, experience acute phases of mental disturbances, and whose behaviour has been identified to pose danger to others. Some common examples of specialist mental health services that can be implemented by the NSW government include acute mental health wards, eating disorder clinics, and suicidal counselling services. The reform has allocated $38 million for increasing the access to specialist mental health services, with $3.6 million for clinical teams, $2.4 million for older adults, and $2.2 million for adolescent and child mental health teams. $39 million has also been assigned for the expansion of psychosocial and living support for individuals who reside in the community (NSW Government, 2018). $2.2 million has also been apportioned for providing adequate training to the workforce, in addition to an extra $1 million for mental health first-aid courses.

Respect has often been defined as the identification of the intrinsic worth, dignity, and exclusivity of every person, irrespective of the socio-economic position, particular attributes and the kind of health problem. Hence, the key components of a therapeutic relationship that needs to be established in a mental health setting are namely, (1) trust, (2) respect, (3) professional intimacy, (4) partnership, (5) caring, and (6) power (Chambers et al., 2014). Hence, the components recognised by the reform, are a correct approach that will be able to facilitate the establishment of a therapeutic milieu, which is essential for mental health advancement and illness prevention. Unconditional positive regard and respect are often communicated via attitudes, actions and activities in the mental health setting. Attitude usually encompasses non-verbal and verbal feelings and communication that help in guiding the actions towards all patients (Trower, Bryant & Argyle, 2013). Individuals living with mental illness also expect to be supported correspondingly in their retrieval, notwithstanding their gender, culture, age, and/or sexual identity.

On the other hand, behavioural health equity is generally achieved by confiscating biased and avoidable obstacles that negotiate with the mental health and wellbeing. The vulnerable population that are found to have reduced access to health services are the Aboriginals and Torres Strait Islanders, the socio-economically disadvantaged, those with intellectual disabilities, mental disorders, and people affected by abuse, neglect, social exclusion, and discrimination. Parker and Milroy (2014) opined that the Aboriginals have also been found to place a great emphasis on their ideas of social, family, emotional, and community wellbeing, which powerfully resonates when they are subjected to different stigma and stereotypes due to their existing mental illnesses. Hence, the reform has been correct in recognising the notion of dignity that is the inalienable and inherent worth of all beings, regardless of their social status such as, gender, race, and physical or mental state.

Therefore, this focus on mental health equity in the reform is a precise owing to the fact that it will help in focusing on presence of fair access and chances to healthcare facilities, and proper resource distribution for alleviating the disadvantages that are experienced by the vulnerable groups. The reform has correctly recognised the role of trauma-informed care, the basic principles of which are trustworthiness, safety, collaboration, choice, and empowerment, in accordance to the essential doctrines of recovery-informed approaches. According to Huckshorn and LeBel (2013) trauma-informed care focuses on the importance of partnership between the service users and the staff, which in turn depends on the assumption that healing and recovery are triggered by meaningful power sharing and decision making. Additionally, principles of the reform are also supported by the fact that it intends to reinforce the clients’, staff’s, and family members’ knowledge and distinguish that every being’s experience is exclusive and necessitates an individualized tactic.

Rutten et al. (2013) stated that mental reforms should comprise of a trust in resilience and in the aptitude of persons, organizations, and societies to reconcile and promote rescue from trauma. The reform has also identified certain indicators that will determine if the mental health and wellbeing of the target population is increasing or decreasing. Promotion of mental wellbeing can be facilitated by the active participation of the people, presence of a peer workforce, and increase in amount of mental health funding (Tambuyzer, Pieters & Van Audenhove, 2014).  The reform has also recognised the role that is played by private psychiatrists, psychologists, general practitioners, nursing staff and allied health professionals. Evidences by Cameron et al. (2014) have acknowledged the importance of enhancing and supporting the capacity to maintain wellness of the vulnerable people, residing in the community, either through the delivery of integrated care enterprises or via the identification and support to medical funding. This will bring about success of the mental health reform and help it achieve its objectives.

Conclusion and recommendation

Thus, it can be stated that the NSW Mental Health Reform 2014-2024 is a primary national coalition that focuses on mental health, and is working towards driving the reform of mental health services that are available in the region. The reform has recognised the demanding agenda that all people suffering from mental illnesses should be providing with the necessary support and access to care services in the community setting, while maintaining their dignity and demonstrating a respect towards their preferences and opinions. Thus, the reform has been found to assert on the principles of social equity. This elaborates on the fact that at any phase of life, regardless of the demographic features, culture, place of residence, social difficulties, and mental health status, all individuals are equal citizens who should presume to discover timely, superior quality mental health support, as and when required. This made the reform illustrate the need of ensuring that the self-respect, dignity, self-confidence of individuals with psychosocial and mental disability is well-looked-after.

Although the NSW government has recognised the need of driving change, in relation to mental health and wellbeing of all citizens, the contemporary economic climate does not hold promise of noteworthy supplementary venture in mental health care. Furthermore, owing to the fact that the reform had been formulated when comes at a time when the governments were taking initiatives for coping with the exponential growth in costs related to hospital services. Basic recommendations for the same requires harnessing local action in order to provide enhanced services to the mentally vulnerable people. Thus, all people who are contributing for the successful implementation of the program must be provided with reliable benefits. Aligning the mental health services of the primary care organisation with the local health districts will also allow the population to access relevant information regarding medical benefit schemes, and pensions. Reinforcing on the use of technology and building provisions for coordinated responses across different human service will also help in success of the reform.

References:

Australian Government. (2018). Chronic disease. Retrieved from https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/chronic-disease/overview.

Beronio, K., Glied, S., & Frank, R. (2014). How the Affordable Care Act and Mental Health Parity and Addiction Equity Act greatly expand coverage of behavioral health care. The journal of behavioral health services & research, 41(4), 410-428.

Cameron, A., Lart, R., Bostock, L., & Coomber, C. (2014). Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature. Health & social care in the community, 22(3), 225-233.

Caplan, G. (2013). An approach to community mental health. Routledge.

Chambers, M., Gallagher, A., Borschmann, R., Gillard, S., Turner, K., & Kantaris, X. (2014). The experiences of detained mental health service users: issues of dignity in care. BMC medical ethics, 15(1), 50.

Dennis, D. L., & Monahan, J. (Eds.). (2013). Coercion and aggressive community treatment: A new frontier in mental health law. Springer Science & Business Media.

Grob, G. N. (2014). From asylum to community: Mental health policy in modern America (Vol. 1217). Princeton University Press.

Huckshorn, K. E. V. I. N., & LeBel, J. L. (2013). Trauma-informed care. Modern community mental health: An interdisciplinary approach, 62-83.

Katon, W. J., & Unützer, J. (2013). Health reform and the Affordable Care Act: the importance of mental health treatment to achieving the triple aim. Journal of Psychosomatic Research, 74(6), 533-537.

Kidd, S. A., McKenzie, K. J., & Virdee, G. (2014). Mental health reform at a systems level: widening the lens on recovery-oriented care. The Canadian Journal of Psychiatry, 59(5), 243-249.

Mendenhall, E., De Silva, M. J., Hanlon, C., Petersen, I., Shidhaye, R., Jordans, M., … & Tomlinson, M. (2014). Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda. Social science & medicine, 118, 33-42.

Mental Health Commission. (2014). LIVING WELL- A STRATEGIC PLAN FOR MENTAL HEALTH IN NSW 2014 – 2024. Retrieved from https://www.health.nsw.gov.au/mentalhealth/reform/Publications/living-well-strategic-plan.pdf.

NSW Government. (2015). NSW Mental Health Reform 2014 – 2024- 12 months on. Retrieved from https://www.health.nsw.gov.au/mentalhealth/reform/Publications/mental-health-reform.pdf.

NSW Government. (2015). NSW Mental Health Reform 2014 – 2024. Retrieved from https://www.health.nsw.gov.au/mentalhealth/reform/Publications/reform-factsheet.pdf.

NSW Government. (2016). Psychological distress in secondary school students. Retrieved from https://www.healthstats.nsw.gov.au/Indicator/men_distrstud/men_distrstud?&topic=Mental%20health&topic1=topic_men&code=men[_]%20bod_dementhos.

NSW Government. (2018). NSW MENTAL HEALTH REFORM $95M FACT SHEET 2017-18. Retrieved from https://www.health.nsw.gov.au/mentalhealth/reform/Factsheets/mhr-2017-18.pdf.

Oldham, J. (2016). Person-centred care. Future Hospital Journal, 3(2), 85-86.

Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait Islander mental health: an overview. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet, 25-38.

Rutten, B. P., Hammels, C., Geschwind, N., Menne?Lothmann, C., Pishva, E., Schruers, K., … & Wichers, M. (2013). Resilience in mental health: linking psychological and neurobiological perspectives. Acta Psychiatrica Scandinavica, 128(1), 3-20.

Senior, J., Birmingham, L., Harty, M. A., Hassan, L., Hayes, A. J., Kendall, K., … & Webb, R. (2013). Identification and management of prisoners with severe psychiatric illness by specialist mental health services. Psychological medicine, 43(7), 1511-1520.

Solbjør, M., Rise, M. B., Westerlund, H., & Steinsbekk, A. (2013). Patient participation in mental healthcare: when is it difficult? A qualitative study of users and providers in a mental health hospital in Norway. International Journal of Social Psychiatry, 59(2), 107-113.

Tambuyzer, E., Pieters, G., & Van Audenhove, C. (2014). Patient involvement in mental health care: one size does not fit all. Health Expectations, 17(1), 138-150.

Trower, P., Bryant, B., & Argyle, M. (2013). Social skills and mental health (psychology revivals). Routledge.

World Health Organization. (2015). DIGNITY IN MENTAL HEALTH. Retrieved from https://www.who.int/mental_health/world-mental-health-day/paper_wfmh_wmhd2015.pdf.

Yang, J. A., & Anthony, V. (2015). Community mental health. The Encyclopedia of Adulthood and Aging, 1-5.